- Actalent (Dayton, OH)
- We are hiring for a Clinical Appeals Nurse (RN). This is a fully remote role for someone who is licensed in Ohio! Description: Job Summary: The Clinical ... Appeals Nurse is responsible for the completion of clinical appeals and state hearings from all states. Essential Functions: * Responsible for the completion… more
- Actalent (Dayton, OH)
- We are currently hiring for a Clinical Appeals Nurse in a fully REMOTE role! A candidate MUST have their RN and be licensed to practice in the state of Ohio. ... to be extended or turn into something more long-term. Description: The Clinical Appeals Nurse is responsible for the completion of clinical appeals and state… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Clinical Appeals Nurse Manager? At Parallon, you come first. HCA Healthcare has committed up ... have the opportunity to make a difference. We are looking for a dedicated Clinical Appeals Nurse Manager like you to be a part of our team. **Job Summary and… more
- CVS Health (Hartford, CT)
- …Basic awareness of problem solving and decision making skills Position Summary The Appeals Nurse Consultant position is responsible for processing the medical ... residence. Position OverviewAdministers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to apply appropriate… more
- Kepro (Indianapolis, IN)
- …solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: Our ... Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations. He or She will… more
- HCA Healthcare (Brentwood, TN)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Appeals Nurse RN you want with your current employer? We have an exciting ... caring group of colleagues. Do you want to work as a Clinical Appeals Nurse RN where your passion for creating positive patient interactions are valued? If… more
- Humana (Des Moines, IA)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records… more
- R1 RCM (Salt Lake City, UT)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and… more
- Penn State Health (Hershey, PA)
- …Kieffer at ###@pennstatehealth.psu.edu 100% Remote Position **SUMMARY OF POSITION:** The clinical appeals nurse will be responsible for reviewing all clinical ... Hospitals. This will include all Pre-pay and Post-pay audit denials. The appeals nurse will subsequently draft any required appeals until the process… more
- CVS Health (Hartford, CT)
- …position are Monday-Friday 8a-5p in time zone of residence. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical ... necessity of Medicare Part C appeals from both members and providers. This role is...a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,… more
- CVS Health (Hartford, CT)
- …residence with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the ... medical necessity of Medicare Part C appeals from both members and providers. This role is...a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,… more
- R1 RCM (Boise, ID)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid… more
- CVS Health (Hartford, CT)
- …business hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity ... of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clinical,… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Appeals - Licensed Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct… more
- Universal Health Services (Richmond, VA)
- …CBO is seeking a dynamic and talented Clinical Documentation Improvement (CDI) Nurse . The Clinical Documentation Improvement (CDI) Nurse provides clinically ... based concurrent and retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services. The goal of concurrent review includes facilitation of appropriate physician documentation of care delivered to… more
- Baptist Memorial (Memphis, TN)
- Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory ... Responsibilities + Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors. + Educates department staff to… more
- UNC Health Care (Chapel Hill, NC)
- …communities we serve. RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse . This person is based at the Hedrick building ... **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional Experience Requirements:**… more
- Kepro (Richmond, VA)
- …for health solutions in the public sector. Acentra seeks a UM Reviewer & Appeals Coordinator RN/LCSW (Remote within Virginia) to join our growing team. Job Summary: ... in a blended role as a clinical reviewer and appeals coordinator. In the clinical reviewer role - you...time to time. Requirements Required Qualifications/Experience: + Active Registered Nurse (RN) license or a Compact License or a… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Clinical Appeals Team Lead? At Parallon, you come first. HCA Healthcare has committed up to $300 ... a difference. We are looking for a dedicated Clinical Appeals Team Lead like you to be a part...substitute experience requirement. + Currently licensed as a registered nurse (RN) or (LPN) in the state(s) of practice… more